Opioid-related deaths in England and Wales from 2011 to 2022 were 54.7 per cent higher than recorded, according to research by King’s College London. While the official Office for National Statistics (ONS) figure was 25,364, King’s researchers estimate the true total at more than 39,200.
The reason for the discrepancy is that ONS bases its figures on the information provided by the coroner on the death certificate, but does not have access to post-mortem reports or toxicology results. If the death certificate is missing information, such as when the death is the result of polydrug use and recorded with ‘ambiguous terms such as “multidrug overdose”, the ONS cannot determine the individual substances involved’, says King’s. This means that while the overall number of drug deaths recorded is likely to be accurate, the death count for specific substances will be limited by lack of available information.
While ONS recorded 574 heroin/morphine related deaths in 2011, the King’s research team used data from coroners’ reports submitted to the university’s National Programme on Substance Use Mortality (NPSUM) to ‘triangulate and better estimate’ the number of opioid-related deaths. Researchers found nearly 240 further unaccounted deaths – equating to an underestimate of 29 per cent. However, by 2022 the gap had risen to 34 per cent, with researchers projecting 1,980 deaths compared to the official ONS figure of 1,264.
The most recent official figures for England and Wales saw 5,448 drug poisoning deaths registered in 2023, up by 11 per cent on the previous year, with 2024’s figures due to be released soon. Although Scotland’s figure for 2024 showed a 13 per cent fall from the previous year, the country still has the highest rate in Europe.
Even the official rate of opioid-related deaths in England and Wales has almost doubled since 2012 – from 22.9 deaths per million to 43.8, with the UK’s drug death totals taking its toll on overall life expectancy. There are fears that the situation could worsen significantly in the coming years, with more highly potent synthetic opioids being detected in the drug supply. King’s is now extending its study to provide estimates for deaths related to other substances, it says, with the number of officially recorded cocaine-related deaths also likely to be underestimated.
‘The UK is grappling with a serious drug-related deaths crisis,’ said NPSUM director and senior author of the King’s report, Dr Caroline Copeland. ‘All these tragic deaths are preventable, but well-meaning policies, treatment programmes and educational campaigns will not have the desired impact unless the true scale of the problem is known – this underestimation will be leading to underfunding. The increase of users taking more than one drug increases the likelihood of accidental overdose and also adds to the reporting problem. We need to alert coroners to the impact that not naming specific drugs as the cause of death has on the planning and funding of public health policies.’
‘Deaths following opioid use have nearly doubled in the last decade, and these figures show an alarming acceleration of this tragedy,’ added WithYou chief executive Simon Phillips. ‘The ONS’ statistics play an important role in influencing public health policy and funding decisions. This under-reporting will have led to treatment services not receiving the levels of funding they require, and people not getting the support they need. With deaths from other drugs also likely to be underestimated, the government must prioritise this issue and commit to sustained, long-term funding for treatment and recovery services – people’s lives depend on it.’
Comparison of Office for National Statistics (ONS) and National Programme on Substance Use Mortality (NPSUM) data suggests that opioid-related deaths in England & Wales have been systematically underestimated, published in the International Journal of Drug Policy and available here